THORACIC KYPHOSIS AND THE PREVALENCE OF ADVANCED UTERINE PROLAPSE

Objective: To determine if there is an association between the degree of thoracic kyphosis and the prevalence of advanced uterine prolapse i n women. Methods: A retrospective case-control study compared the degr ee of thoracic kyphosis among white women with advanced uterine prolap se with that of matched controls. Medical records were reviewed for 41 2 consecutive women who underwent either abdominal or vaginal hysterec tomy. The cases were those with uterine prolapse to or beyond the leve l of the introitus, and women with no evidence of prolapse served as c ontrols. Spinal curvature was measured preoperatively for each patient using a lateral chest x-ray and the Ferguson method. Forty-eight case s were matched to 48 controls for age, weight, menopausal status, and hormonal status. Results were stratified to analyze the effect of pari ty on the relationship between uterine prolapse and thoracic kyphosis. Results: The degree of thoracic kyphosis was higher in patients with uterine prolapse than in controls (mean paired difference = 4.9 degree s, 95% confidence interval [CI] 3.1-6.7; P < .001). Patients with uter ine prolapse had a mean spinal curvature of 13.0 degrees (95% CI 11.5- 14.5), whereas controls had one of 8.1 degrees (95% CI 6.9-9.4). A hig her degree of thoracic kyphosis was associated with an incremental hig her occurrence of uterine prolapse (odds ratio 1.35, 95% CI 1.11-1.65; P < .01). Conclusion: Thoracic kyphosis appears to be associated with uterine prolapse.